Provider Demographics
NPI:1891007498
Name:KEVILLE, MEAGHAN PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:PATRICIA
Last Name:KEVILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:PATRICIA
Other - Last Name:NELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:CSTARS
Mailing Address - Street 2:22 S GREENE ST
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-328-0398
Mailing Address - Fax:410-328-7549
Practice Address - Street 1:CSTARS
Practice Address - Street 2:22 S GREENE ST
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-0398
Practice Address - Fax:410-328-7549
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH099429207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine